Spectral domain optical coherence tomography characteristics of retained subretinal perfluoro-n-octane

To describe the spectral domain optical coherence tomography characteristics of retained subretinal perfluoro-n-octane (SR-PFO) after vitreoretinal surgery.

Consecutive patients referred for retained SR-PFO after pars plana vitrectomy for retinal detachment were prospectively evaluated with spectral domain optical coherence tomography. The clinical findings, fundus autofluorescence, spectral domain optical coherence tomography images, and anatomical outcomes, were reviewed.

Three consecutive patients presented to the vitreoretinal service with history of retinal detachment and pervious vitrectomy with intraoperative PFO. Subretinal PFO bubbles were observed on clinical examination and imaging studies, including spectral domain optical coherence tomography. Case 1 had subfoveal PFO removal and developed a postoperative choroidal neovascular membrane. Case 2 had multiple foci of SR-PFO after giant retinal tear repair. Case 3 had superotemporal SR-PFO that remained stable for several years without migration or other associated pathology.

Subretinal PFO appears as a low-reflectance spherical mass, often with a pinpoint focus of hyperreflectance at the apex of the bubble. Optical coherence tomography details beneath subretinal PFO appear relatively hyperreflectant compared to adjacent tissue. Long-term observation revealed preferential absence of the outer retinal layers with no nerve fiber layer erosion, subretinal inflammatory precipitates, or proliferative vitreoretinopathy. Some evidence of retinal pigment epithelial disruption was observed but seemed to remain stable or improve with observation. The authors suggest management involving follow-up with close observation in SR-PFO unless present in the subfoveal region. Choroidal neovascular membrane can occur after SR-PFO removal and may be successfully managed with intravitreal bevacizumab.